军事医学科学院干细胞与再生医学研究回顾与展望

干细胞具有高度自我更新、增殖和多向分化潜能,因而成为再生医学的基础.作为中国干细胞研究与应用的＂先驱＂单位和优势单位之一,我院早期开展造血干细胞生物学性能、造血调控机制、造血干/祖细胞扩增和定向诱导分化的研究,取得了一系列重要成果.相继开展的造血干细胞移植等系列研究和应用也取得了突出的成绩.近年来,我院又系统开展了胚胎干细胞自我更新与干性维持机制、干细胞增殖分化调控、干细胞建系与建库技术造血发育调控与造血干细胞移植新策略、成体干细胞治疗、肿瘤干细胞筛选与鉴定、干细胞为种子细胞的三维组织构建、干细胞再生相关药物等多个领域的研究,并取得突出进展进一步我们将瞄准干细胞与再生医学的重大科学问题和关键技术,建立高水平的研究和应用基地,形成我院干细胞与再生医学研究开发的关键技术体系,研发系列具有自主知识产权的关键技术和产品,并培养优秀的科研团队,进入世界先进行列.     

卵巢癌肿瘤干细胞研究现状与展望

卵巢癌在妇科恶性肿瘤中致死率较高,早期难以发现,对化疗易耐药,而且易转移复发,5年存活率低于30%。TSCs学说认为卵巢癌易耐药、复发及转移,根源在于TSCs所致,只有针对TSCs进行特异性治疗,才能进一步提高对卵巢癌的治疗效果。本文就卵巢癌TSCs分离鉴定、靶向治疗的研究现状及其展望作一综述。     

干细胞治疗：从研发到应用

干细胞治疗的应用既离不开基础研究的发展和技术的不断进步,也离不开科技政策的支持、生产工艺的进步、临床研究的发展,以及企业对干细胞相关产品的开发。本文从管理政策、生产技术、临床研究、产品开发等多个角度,就与干细胞治疗相关的研究现状和前景进行评述。     

干细胞生物工程研究展望

 由于最近两年干细胞研究技术的突破 ,一门崭新的学科“干细胞生物工程”已经形成 .人类胚胎干细胞在体外的成功培养以及一种组织的干细胞 (成体干细胞 )向另一种组织细胞横向分化的发现 ,为利用“干细胞生物工程”技术治疗疾病奠定了基础 .本综述着重介绍干细胞研究领域的一些新概念和新技术以及干细胞分化的基因调控 .对干细胞生物工程的临床应用前景作了概括性讨论     

神经干细胞移植的临床研究进展

神经系统损伤会导致脑内神经干细胞（neural stem cells,NSCs）的扩增以实现自我修复功能,而通过外源细胞移植的方式来加速这一进程,可能是一种更有效的治疗手段。当前,神经干细胞临床研究所面临的主要问题是如何评价细胞在移植后的行为和功能。该文综述了近几年使用神经干细胞移植治疗几种主要神经系统疾病的临床研究成果,并着重关注了干细胞移植后的示踪研究。     

世界各国干细胞治疗相关政策与规划分析

随着生物技术的迅速发展,干细胞（stem cell）作为具有复制和多向分化功能的集体起源细胞,对人体发育、衰老和疾病的治疗有着巨大的作用,受到世界各国的普遍关注。自从20世纪末美国Science（《科学》）杂志两年连续两次将干细胞生物学和干细胞生物工程评为世界十大科学成就之首以来,干细胞领域就持续成为国内外医学和生物学研究的热点。人们期待着干细胞技术能很快产业化,形成治疗产品,用来重建和修复病变或衰老的组织器官。     

成体干细胞可塑性的事实、质疑和展望

成体干细胞的可塑性是指存在于成年组织或器官中的不成熟细胞跨胚层分化的一种能力。近年来相关研究很多,有人认为成体干细胞具有可塑性,如造血干细胞可以分化为神经外胚层细胞和内胚层细胞：有人对其持怀疑态度,认为成年造血干细胞发育可塑性证据不足,成体干细胞不能跨胚层分化。由于分离纯化、检测手段等的局限,大多数研究均存在这样或那样的不足和误区,彻底研究清楚还有很长的路要走。     

肝癌干细胞的研究现状

肿瘤发生的癌干细胞假说认为肿瘤组织是由处于各种分化等级的细胞组成的,其中的癌干细胞数量虽少,但在肿瘤的发生、恶化、转移中起重要作用。肝细胞癌作为最常见的恶性肿瘤之一,其中是否存在“肝癌干细胞”的问题一直倍受人们关注。该文介绍肝癌干细胞的研究情况。     

骨髓干细胞移植治疗肝硬化的基础与临床研究现状

肝硬化是一种临床常见的肝病良性终末期表现。目前临床上尚缺乏有效的治疗措施。肝脏移植是最理想的治疗方法,但受供体肝脏来源限制,且费用昂贵。近年来开展的自体骨髓干细胞(BMSCs)移植治疗,为肝硬化的治疗带来了新的希望。BMSCs主要包括造型血干细胞和间充质干细胞,其具有可塑性,体外通过生长因子,体内利用特定微环境均可诱导BMSCs分化为肝前体细胞和成熟肝细胞,并明显改善肝功能。从动物实验到临床研究亦表明,BMSCs具有来源丰富、费用低廉、损伤小、自体移植不栓塞、无排斥反应等优点,为治疗肝病带来了新思路,有望成为生物人工肝的细胞来源。本文就BMSCs移植治疗肝硬化的研究现状,尤其是移植途径以及在肝脏内定居、迁移和分化机制的示踪观察方法和存在的问题作一综述,以期为从事肝病研究的同仁提供参考依据。通过对BMSCs移植从基础研究及临床应用的最新进展的描述,展示BMSCs在肝硬化治疗方面良好的治疗前景。     

Stem cell therapy in stroke: designing clinical trials

Stroke is a common and disabling condition that represents a potentially attractive target for regenerative therapy. Stem cells from a wide range of origins have been investigated in studies using animal models of stroke, with evidence that neural or mesenchymal cells migrate to the site of ischemic injury after intravascular or intraparenchymal delivery, and that a proportion of cells survive and differentiate into cells with characteristics of neurons or glia. In some studies there is evidence of electrical function of transplanted cells. Some studies report improvements in neurological function with cell implantation even when undertaken up to 30 days after the stroke is induced. Few clinical trials have been undertaken to date, with two studies of a teratocarcinoma-derived cell line delivered by direct brain injection, and two of bone-marrow derived mesenchymal stem cells delivered intravascularly. Ongoing trials of other cell lines are exploring safety. There are considerable difficulties in designing future efficacy trials, some being generic to the field of regenerative treatment in stroke, and some that are specific to stem cells or their mode of delivery.     

Effect of metformin on stem cells: Molecular mechanism and clinical prospect

Metformin is a first-line medication for type II diabetes. Numerous studies have shown that metformin not only has hypoglycemic effects, but also modulates many physiological and pathological processes ranging from aging and cancer to fracture healing. During these different physiological activities and pathological changes, stem cells usually play a core role. Thus, many studies have investigated the effects of metformin on stem cells. Metformin affects cell differentiation and has promising applications in stem cell medicine. It exerts anti-aging effects and can be applied to gerontology and regenerative medicine. The potential anti-cancer stem cell effect of metformin indicates that it can be an adjuvant therapy for cancers. Furthermore, metformin has beneficial effects against many other diseases including cardiovascular and autoimmune diseases. In this review, we summarize the effects of metformin on stem cells and provide an overview of its molecular mechanisms and clinical prospects.     

Application of mesenchymal stem cell therapy for the treatment of osteoarthritis of the knee: A concise review

Osteoarthritis(OA) refers to a chronic joint disease characterized by degenerative changes of articular cartilage and secondary bone hyperplasia. Since articular cartilage has a special structure, namely the absence of blood vessels as well as the low conversion rate of chondrocytes in the cartilage matrix, the treatment faces numerous clinical challenges. Traditional OA treatment(e.g., arthroscopic debridement, microfracture, autologous or allogeneic cartilage transplantation,chondrocyte transplantation) is primarily symptomatic treatment and pain management, which cannot contribute to regenerating degenerated cartilage or reducing joint inflammation. Also, the generated mixed fibrous cartilage tissue is not the same as natural hyaline cartilage. Mesenchymal stem cells(MSCs) have turned into the most extensively explored new therapeutic drugs in cell-based OA treatment as a result of their ability to differentiate into chondrocytes and their immunomodulatory properties. In this study, the preliminary results of preclinical(OA animal model)/clinical trials regarding the effects of MSCs on cartilage repair of knee joints are briefly summarized, which lay a solid application basis for more and deeper clinical studies on cell-based OA treatment.     

Mesenchymal stem cell therapy in retinal and optic nerve diseases: An update of clinical trials

Retinal and optic nerve diseases are degenerative ocular pathologies which lead to irreversible visual loss. Since the advanced therapies availability, cell-based therapies offer a new all-encompassing approach. Advances in the knowledge of neuroprotection, immunomodulation and regenerative properties of mesenchymal stem cells(MSCs) have been obtained by several preclinical studies of various neurodegenerative diseases. It has provided the opportunity to perform the translation of this knowledge to prospective treatment approaches for clinical practice. Since 2008, several first steps projecting new treatment approaches, have been taken regarding the use of cell therapy in patients with neurodegenerative pathologies of optic nerve and retina. Most of the clinical trials using MSCs are in Ⅰ/Ⅱ phase, recruiting patients or ongoing, and they have as main objective the safety assessment of MSCs using various routes of administration. However, it is important to recognize that, there is still a long way to go to reach clinical trials phase Ⅲ-Ⅳ. Hence, it is necessary to continue preclinical and clinical studies to improve this new therapeutic tool. This paper reviews the latest progress of MSCs in human clinical trials for retinal and optic nerve diseases.     

Adult human neural stem cell therapeutics: Current developmental status and prospect

Over the past two decades, regenerative therapies using stem cell technologies have been developed for various neurological diseases. Although stem cell therapy is an attractive option to reverse neural tissue damage and to recover neurological deficits, it is still under development so as not to show significant treatment effects in clinical settings. In this review, we discuss the scientific and clinical basics of adult neural stem cells (aNSCs), and their current developmental status as cell therapeutics for neurological disease. Compared with other types of stem cells, aNSCs have clinical advantages, such as limited proliferation, inborn differentiation potential into functional neural cells, and no ethical issues. In spite of the merits of aNSCs, difficulties in the isolation from the normal brain, and in the in vitro expansion, have blocked preclinical and clinical study using aNSCs. However, several groups have recently developed novel techniques to isolate and expand aNSCs from normal adult brains, and showed successful applications of aNSCs to neurological diseases. With new technologies for aNSCs and their clinical strengths, previous hurdles in stem cell therapies for neurological diseases could be overcome, to realize clinically efficacious regenerative stem cell therapeutics.     

WJSC 6th Anniversary Special Issues（2）:Mesenchymal stem cells Neurotrauma and mesenchymal stem cells treatment:From experimental studies to clinical trials

Mesenchymal stem cell(MSC)therapy has attracted the attention of scientists and clinicians around the world.Basic and pre-clinical experimental studies have highlighted the positive effects of MSC treatment after spinal cord and peripheral nerve injury.These effects are believed to be due to their ability to differentiate into other cell lineages,modulate inflammatory and immunomodulatory responses,reduce cell apoptosis,secrete several neurotrophic factors and respond to tissue injury,among others.There are many pre-clinical studies on MSC treatment for spinal cord injury(SCI)and peripheral nerve injuries.However,the same is not true for clinical trials,particularly those concerned with nerve trauma,indicating the necessity of more well-constructed studies showing the benefits that cell therapy can provide for individuals suffering the consequences of nerve lesions.As for clinical trials for SCI treatment the results obtained so far are not as beneficial as those described in experimental studies.For these reasons basic and pre-clinical studies dealing with MSC therapy should emphasize the standardization of protocols that could be translated to the clinical set with consistent and positive outcomes.This review is based on pre-clinical studies and clinical trials available in the literature from 2010 until now.At the time of writing this article there were 43 and 36 pre-clinical and 19 and 1 clinical trials on injured spinal cord and peripheral nerves,respectively.     

Mesenchymal stem cells in neurodegenerative diseases: Opinion review on ethical dilemmas

The treatment of neurodegenerative diseases presents a growing need for innovation in relation to recent evidence in the field of reconstructive therapy using stem cells. Understanding the molecular mechanisms underlying neurodegenerative disorders, and the advent of methods able to induce neuronal stem cell differentiation allowed to develop innovative therapeutic approaches offering the prospect of healthy and perfectly functional cell transplants, able to replace the sick ones. Hence the importance of deepening the state of the art regarding the clinical applications of advanced cell therapy products for the regeneration of nerve tissue. Besides representing a promising area of tissue transplant surgery and a great achievement in the field of neurodegenerative disease, stem cell research presents certain critical issues that need to be carefully examined from the ethical perspective. In fact, a subject so complex and not entirely explored requires a detailed scientific and ethical evaluation aimed at avoiding improper and ineffective use, rather than incorrect indications, technical inadequacies, and incongruous expectations. In fact, the clinical usefulness of stem cells will only be certain if able to provide the patient with safe, long-term and substantially more effective strategies than any other treatment available.The present paper provides an ethical assessment of tissue regeneration through mesenchymal stem cells in neurodegenerative diseases with the aim to rule out the fundamental issues related to research and clinical translation.     

中国细胞重编程和多能干细胞研究进展

近几十年是干细胞领域飞速发展的重要时期。随着中国经济实力的发展壮大,科研实力也在稳步增强,干细胞研究领域达到了国际并跑甚至领跑的水平。本文从体细胞核移植、诱导多能干细胞、单倍体多能干细胞和胚胎早期发育研究4个方面,对中国细胞重编程和干细胞领域的研究进展进行了历史性回顾,总结了中国科学家在相关领域所取得的重要科研成果。随着单细胞测序技术的发展,各种发育过程将实现更为深入的解读,干细胞的临床应用在中国也会大放异彩。